Cell-free DNA in plasma as an essential immune system regulator

The cell-free DNA (cfDNA) is always present in plasma, and it is biomarker of growing interest in prenatal diagnostics as well as in oncology and transplantology for therapy efficiency monitoring. But does this cfDNA have a physiological role? Here we show that cfDNA presence and clearance in plasma of healthy individuals plays an indispensable role in immune system regulation. We exposed THP1 cells to healthy individuals' plasma with (NP) and without (TP) cfDNA. In cells treated with NP, we found elevated expression of genes whose products maintain immune system homeostasis. Exposure of cells to TP triggered an innate immune response (IIR), documented particularly by elevated expression of pro-inflammatory interleukin 8. The results of mass spectrometry showed a higher abundance of proteins associated with IIR activation due to the regulation of complement cascade in cells cultivated with TP. These expression profiles provide evidence that the presence of cfDNA and its clearance in plasma of healthy individuals regulate fundamental mechanisms of the inflammation process and tissue homeostasis. The detailed understanding how neutrophil extracellular traps and their naturally occurring degradation products affect the performance of immune system is of crucial interest for future medical applications.

Proteomic approach for identification of IgA nephropathy-related biomarkers in urine

Proteinuria is often used as a surrogate marker in monitoring and predicting outcome in patients with chronic kidney diseases, but it is non-specific. IgAN belongs to the most common primary glomerulonephritis worldwide with serious prognosis. The main aim of this work was to assess differences in urine proteins in patients with IgA nephropathy and to identify abnormal proteins as potential biomarkers of IgA nephropathy or the renal disease. In our pilot project, we selected 20 patients and compared them with 20 healthy volunteers. Protein quantification was performed using iTRAQ (isobaric tag for relative and absolute quantitation) labeling method. The peptides were separated by the isoelectric focusing method (IEF) and nano-LC with C18 column and identified by mass spectrometry using MALDI-TOF/TOF MS. Proteins´ lists obtained from IEF-LC-MS-MS/MS analysis were combined and contained 201 proteins. It was found out that 113 proteins were common in both experiments. 30 urinary proteins were significantly up- or down-regulated in patients with IgA nephropathy. We characterized potential biomarkers such as alpha-1-antitrypsin, apolipoprotein A-I, CD44 antigen or kininogen. Potential biomarkers of IgAN should be validated in further studies.

[Arthroscopic stabilization procedure for multidirectional shoulder instability]

PURPOSE OF THE STUDY

The authors describe an arthroscopic procedure for multidirectional shoulder instability and its results in a group of their patients. They present a new argument to the widely accepted view that multidirectional instability of the shoulder is not an indication to surgical treatment.

MATERIAL

A total of nine shoulders in seven patients were indicated to surgical intervention because of multidirectional shoulder instability. The average age of the patients was 19 years. Two patients underwent a bilateral procedure. Based on the preoperative clinical findings, two groups were distinguished: the patients with loose shoulders who, with overhead use of the arm, suffered from recurrent subluxations dorsally or caudally, and those who were able to voluntarily dislocate the glenohumeral joint as well as to reduce it spontaneously (habitual posterior dislocation). The patients were evaluated at one year follow-up using the Rowe and Zarins criteria. Patients with unidirectional instability of the shoulder were not included in the study.

METHODS

All patients diagnosed with multiple recurrent posterior dislocations of the shoulder were indicated for surgery. After clinical examination, arthroscopy was carried out in a lateral recumbent position and, according to the findings, first capsulorrhaphy of the posterior capsule of the joint and reattachment of the labrum were performed, and then a similar intervention was carried out on the anterior part of the joint. For the operation, only two incisions were made, one for insertion of the arthroscope, the other for the instruments, and they were used interchangeably. Both absorbable and non-absorbable anchors were used and the capsule was fixed with a sliding knot. Subsequently, the shoulder was immobilized in a Desault bandage for 6 weeks, then rehabilitation was carried out. Full activity including sports was allowed beginning with the third month after surgery.

RESULTS

Shoulder stability was achieved in all patients. After the procedure, no voluntary dislocation of the joint in the posterior direction or subluxations of the shoulder with overhead use of the arm were recorded. All patients, who had had serious problems pre-operatively, were satisfied with the results and would undergo the arthroscopic procedure again. Therefore, the therapy can be regarded as very effective.

DISCUSSION

Our results of operative treatment contradict the generally accepted view that multidirectional shoulder instability is not indicated for surgical treatment, and the only therapy recommended to the patients is shoulder muscle strengthening, with avoidance of excessive motion range. This approach has persisted since the time when open surgery permitted either an anterior or a posterior intervention, but not both at the same stage. Today, arthroscopic reconstruction of the whole capsule is possible, with only a minimal interference with the shoulder muscles. Therefore, its benefits for the patients are undisputable.

CONCLUSIONS

Arthroscopic stabilization of the shoulder for the treatment of multidirectional instability is a demanding procedure; however, if performed technically well, it is very efficient and provides good outcomes for patients with this diagnosis.

Downregulation of myc promoter-binding protein 1 (MBP-1) in growth-arrested malignant B cells

Normal human B lymphocytes are sensitive to the growth-inhibitory action of TGF-beta1 whereas malignant B lymphoma cells are mostly resistant to TGF-beta1 effects. We have shown in our previous work that, TGF-beta1 treatment resulted in significant growth inhibition of the DoHH2 cell line. In the present study we showed that TGF-beta1-induced growth arrest was associated with notable downregulation of the myc-binding protein-1 (MBP-1). Moreover, our results indicated that c-Myc overexpression in TGF-beta1-arrested malignant B cells is mediated by binding of MBP-1, as a transcription repressor, to the (+118/+153) element of the promoter region of the myc gene.

Plasma catecholamines: follow-up on 10-year study in health and cardiovascular disease

The predictive value of blood pressure (BP), heart rate (HR), and catecholamines in terms of any subsequent development of cardiovascular disease was investigated. Systolic (S) and diastolic (D) BP, HR, epinephrine (E) and norepinephrine (NE) were measured three times a year in 1980, 1984, and 1989 on 20 clinically healthy subjects, 18 patients with 'essential hypertension', and 22 patients with angina pectoris. Of the 22 patients in the latter group, 15 died during a 2-year follow-up (1990-1991). Each individual data series was analyzed by single cosinor to assess the circannual variation. Results were summarized by population-mean cosinor for each group. Parameter tests were used to compare the circannual rhythm characteristics among the different patient groups. A circannual rhythm was invariably demonstrated on a group basis (P < 0.05). Differences in MESOR and/or circannual amplitude were found among the different groups. In particular, patients with angina pectoris who will die within the 2-year follow-up differ in terms of their E and NE from all other patient groups, a difference already detected at the beginning of the study, more than 10 years before they die. A similar separation is not achieved in terms of BP or HR.

Chronobiologically explored effects of Telmisartan

Effects of Micardis (Telmisartan), alone or with low-dose aspirin, on blood pressure and other cardiovascular endpoints are examined in 20 patients with MESOR-hypertension in a crossover, double-blind, randomized study consisting of three stages, each lasting 7 days: I-placebo, II-Micardis, and III-Micardis with low-dose aspirin. Treatment was administered each day at a different circadian stage, upon awakening, and 3, 6, 9, 12, 15 and 18 hr after awakening. During each stage, the following variables were measured at 3-hr intervals during waking: systolic and diastolic blood pressure, heart rate, ejection fraction, intrarenal resistive index, acceleration time, and serum creatinine. Each data series was analyzed by single cosinor. Results were summarized by population-mean least squares spectra. At matched treatment times, the MESOR and circadian amplitude of each variable were compared among the three treatments by paired t-tests. A prominent circadian rhythm characterizes all variables. Micardis was associated not only with a lowering of blood pressure, but also with a reduction of the circadian blood pressure amplitude. The ejection fraction was increased, and the resistive index and acceleration time were decreased, the effect being more pronounced when low-dose aspirin was added to Micardis. Any circadian-stage dependent effect of Micardis, with or without low-dose aspirin, will require monitoring over spans longer than a single day for a given treatment administration time.

Chronoastrobiology: proposal, nine conferences, heliogeomagnetics, transyears, near-weeks, near-decades, phylogenetic and ontogenetic memories

"Chronoastrobiology: are we at the threshold of a new science? Is there a critical mass for scientific research?" A simple photograph of the planet earth from outer space was one of the greatest contributions of space exploration. It drove home in a glance that human survival depends upon the wobbly dynamics in a thin and fragile skin of water and gas that covers a small globe in a mostly cold and vast universe. This image raised the stakes in understanding our place in that universe, in finding out where we came from and in choosing a path for survival. Since that landmark photograph was taken, new astronomical and biomedical information and growing computer power have been revealing that organic life, including human life, is and has been connected to invisible (non-photic) forces, in that vast universe in some surprising ways. Every cell in our body is bathed in an external and internal environment of fluctuating magnetism. It is becoming clear that the fluctuations are primarily caused by an intimate and systematic interplay between forces within the bowels of the earth--which the great physician and father of magnetism William Gilbert called a 'small magnet'--and the thermonuclear turbulence within the sun, an enormously larger magnet than the earth, acting upon organisms, which are minuscule magnets. It follows and is also increasingly apparent that these external fluctuations in magnetic fields can affect virtually every circuit in the biological machinery to a lesser or greater degree, depending both on the particular biological system and on the particular properties of the magnetic fluctuations. The development of high technology instruments and computer power, already used to visualize the human heart and brain, is furthermore making it obvious that there is a statistically predictable time structure to the fluctuations in the sun's thermonuclear turbulence and thus to its magnetic interactions with the earth's own magnetic field and hence a time structure to the magnetic fields in organisms. Likewise in humans, and in at least those other species that have been studied, computer power has enabled us to discover statistically defined endogenous physiological rhythms and further direct effects that are associated with these invisible geo- and heliomagnetic cycles. Thus, what once might have been dismissed as noise in both magnetic and physiological data does in fact have structure. And we may be at the threshold of understanding the biological and medical meaning and consequences of these patterns and biological-astronomical linkages as well. Structures in time are called chronomes; their mapping in us and around us is called chronomics. The scientific study of chronomes is chronobiology. And the scientific study of all aspects of biology related to the cosmos has been called astrobiology. Hence we may dub the new study of time structures in biology with regard to influences from cosmo- helio- and geomagnetic rhythms chronoastrobiology. It has, of course, been understood for centuries that the movements of the earth in relation to the sun produce seasonal and daily cycles in light energy and that these have had profound effects on the evolution of life. It is now emerging that rhythmic events generated from within the sun itself, as a large turbulent magnet in its own right, can have direct effects upon life on earth. Moreover, comparative studies of diverse species indicate that there have also been ancient evolutionary effects shaping the endogenous chronomic physiological characteristics of life. Thus the rhythms of the sun can affect us not only directly, but also indirectly through the chronomic patterns that solar magnetic rhythms have created within our physiology in the remote past. For example, we can document the direct exogenous effects of given specific solar wind events upon human blood pressure and heart rate. We also have evidence of endogenous internal rhythms in blood pressure and heart rate that are close to but not identical to the period length of rhythms in the solar wind. These were installed genetically by natural selection at some time in the distant geological past. This interpretive model of the data makes the prediction that the internal and external influences on heart rate and blood pressure can reinforce or cancel each other out at different times. A study of extensive clinical and physiological data shows that the interpretive model is robust and that internal and external effects are indeed augmentative at a statistically significant level. Chronoastrobiological studies are contributing to basic science--that is, our understanding is being expanded as we recognize heretofore unelaborated linkages of life to the complex dynamics of the sun, and even to heretofore unelaborated evolutionary phenomena. Once, one might have thought of solar storms as mere transient 'perturbations' to biology, with no lasting importance. Now we are on the brink of understanding that solar turbulences have played a role in shaping endogenous physiological chronomes. There is even documentation for correlations between solar magnetic cycles and psychological swings, eras of belligerence and of certain expressions of sacred or religious feelings. Chronoastrobiology can surely contribute to practical applications as well as to basic science. It can help develop refinements in our ability to live safely in outer space, where for example at the distance of the moon the magnetic influences of the sun will have an effect upon humans unshielded by the earth's native magnetic field. We should be better able to understand these influences as physiological and mechanical challenges, and to improve our estimations of the effects of exposure. Chronoastrobiology moreover holds great promise in broadening our perspectives and powers in medicine and public health right here upon the surface of the earth. Even the potential relevance of chronoastrobiology for practical environmental and agricultural challenges cannot be ruled out at this early stage in our understanding of the apparently ubiquitous effects of magnetism and hence perhaps of solar magnetism on life. The evidence already mentioned that fluctuations in solar magnetism can influence gross clinical phenomena such as rates of strokes and heart attacks, and related cardiovascular variables such as blood pressure and heart rate, should illustrate the point that the door is open to broad studies of clinical implications. The medical value of better understanding magnetic fluctuations as sources of variability in human physiology falls into several categories: 1) The design of improved analytical and experimental controls in medical research. Epidemiological analyses require that the multiple sources causing variability in physiological functions and clinical phenomena be identified and understood as thoroughly as possible, in order to estimate systematic alterations of any one variable. 2) Preventive medicine and the individual patients'care. There are no flat 'baselines', only reference chronomes. Magnetic fluctuations can be shown statistically to exacerbate health problems in some cases. The next step should be to determine whether vulnerable individuals can be identified by individual monitoring. Such vulnerable patients may then discover that they have the option to avoid circumstances associated with anxiety during solar storms, and/or pay special attention to their medication or other treatments. Prehabilitation by self-help can hopefully complement and eventually replace much costly rehabilitation. 3) Basic understanding of human physiological mechanisms. The chronomic organization of physiology implies a much more subtle dynamic integration of functions than is generally appreciated. All three categories of medical value in turn pertain to the challenges for space science of exploring and colonizing the solar system. The earth's native magnetic field acts like an enormous umbrella that offers considerable protection on the surface from harsh solar winds of charged particles and magnetic fluxes. The umbrella becomes weaker with distance from the earth and will offer little protection for humans, other animals, and plants in colonies on the surface of the moon or beyond. Thus it is important before more distant colonization is planned or implemented to better understand those magnetism-related biological- solar interactions that now can be studied conveniently on earth. (ABSTRACT TRUNCATED)

[Fracture of the neck of the talus with pantalar dislocation (case report)]

The author describes the treatment of a fracture of the neck of the talus with pantalar dislocation. In this injury, healing prognosis depends on the preservation of blood supply to the talus, because there is high risk of necrosis development in the body of the talus. He reports a good functional outcome of conservative therapy by closed reduction followed by immobilization for 3 months and avoidance of using the leg for 6 months. Three years after the injury the patient was without any necrotic signs in the body of the talus, and returned fully to his sports activities at the same level as before the injury.

[Perioperative hypothermia and its sequelae]

Perioperative hypothermia is associated with the development of haemocoagulation, cardiovascular and metabolic disorders leading to an increased morbidity and mortality. The objective of the investigation was to assess the extent of hypothermia and its clinical and laboratory consequences. A group of 30 patients subjected to elective radical laparotomy on account of colorectal carcinoma was divided into to equivalent groups. To the first group heated infusions were administered, to the second group not heated ones. In all patients the central and peripheral temperature, rate of postoperative normalization of the temperature, postoperative thermal comfort, consumption of analgesics and biochemical and haematological parameters were monitored.

RESULTS

In patients with non-heated infusions more marked and longer perioperative hypothermia was recorded with a significant alteration of the number of leucocytes and thrombocytes. In the other investigated indicators there was no significant difference between the two groups. Hypothermia did not cause serious complications in any of the patients.

CONCLUSION

Although no serious clinical complications induced by hypothermia were recorded, the authors recommend an active approach and provisions for the perioperative maintenance of body temperature as a standard of contemporary perioperative care.

[A rare case of necrotizing fasciitis and subsequent sepsis with multiorgan failure caused by Vibrio vulnificus]

The authors report a rare case of necrotizing fasciitis, sepsis caused by a strain of Vibrio vulnificus rare in Czech Republic.

[Vascular changes in essential hypertension after treatment with enalapril]

A group of patients with essential hypertension and healthy subjects from the same work place were investigated for a period of four weeks and were subjected, in addition to a basic clinical medical examination, to an ergometric examination ECHO cardiography, occlusion plethysmography, and concurrently serum levels of adrenaline (A), noradrenaline (NA), renin, cyclic adenosine monophosphate (cAMP) beta receptors before and after four weeks treatment with enalapril were assessed. The results are consistent with available data from the literature where administration of inhibitors of the angiotensin converting enzyme (ACE) caused a reduction of the peripheral vascular resistance and increased blood flow assessed by means of occlusion plethysmography. Similar results were recorded after captopril administration for a one year period, as reported by Agabiti-Rose (1). Statistically significant differences were detected between hypertonics given placebo and those given enalapril for four weeks, as regards blood flow at rest and peripheral vascular resistance at rest. There was also a significant difference when hypertonic and normotonic subjects were compared. The results are presented in tables and figures.

[Relation between echocardiographic indicators and beta 2-adrenergic receptors in essential hypertension during treatment with enalapril]

A group of 22 men with essential hypertension stage I and II according to WHO, mean age 29.1 +/- 1.4 years, was divided at random into two sub-groups. Eleven patients were treated for four weeks with enalapril (E), 10 mg/day, 11 patients were given placebo (P), also for a period of four weeks. The patients were subjected to echocardiographic examination before and after four-week therapy with enalapril or placebo. In patients treated with E a significant reduction of the left ventricular wall and the interventricular septum was observed. There was also a highly significant decline of the weight of the left ventricle and the index of left ventricular mass. Enalapril led to a decline of the specific binding capacity and affinity of beta 2-adrenergic lymphocyte receptors. In the group given P no differences were found during the examination repeated after four weeks. By means of multidimensional linear regression estimates a close relationship was revealed between the difference in the weight of the left ventricle, the difference of the index of left ventricular mass and the difference of specific binding capacity and affinity of beta 2-adrenergic lymphocyte receptors.